In a recent blog post, we discussed a new antitrust decision from the North Carolina Business Court that involves healthcare providers and health insurers. In that post, we examined the significance of that opinion to...more

A recent New Jersey appeals court case demonstrates how important it is for families to come up with a long-term care plan before an emergency strikes. The case involves two brothers who got into a fight over whether to place...more

On March 24, the D.C. Circuit held oral argument on Anthem's appeal in United States v. Anthem, in which Anthem sought to have the appellate court overturn District Court Judge Amy Berman Jackson's ruling that barred the...more

On March 8, the House’s Education and Workforce Committee passed a bill, HR 1313 – Preserving Employee Wellness Programs Act. The bill, which was introduced by U.S. Rep. Virginia Foxx in order to “reaffirm existing law to...more

On April 3, Judge Eduardo Robreno, District Judge for the Eastern District of Pennsylvania, granted judgment to a collection of insurer defendants in an antitrust conspiracy case brought against them by heart monitoring...more

This case demonstrates the need for providers to know and follow the notification provisions set forth in their insurance policies in order to avoid an inadvertent loss of coverage.
Once again, the terms of a hospital’s...more

Strange as it sounds, Missouri state law allowed federal workers to recover medical bills twice: once under their federal health insurance plan and again from the person (or person’s insurer) responsible for their injuries. ...more

The Florida Supreme Court declared that the attorney-client privilege shielded a motor vehicle accident plaintiff from being required to disclose that her attorney had referred her to a doctor for treatment. In Worley v....more

The Second Circuit affirmed the dismissal of two False Claims Act ("FCA") cases brought by private relators against insurance and other companies based on the alleged failure to reimburse the Centers for Medicare & Medicaid...more

You know that to apply an exclusion in a policy, the claims administrator must show that the claimant received the policy.
But what happens when the claimant submits a declaration disputing your proof that she received...more

Most states have laws either requiring or permitting mental health professionals to disclose information about patients who may become violent. These voluntary or mandatory reporting laws require a balancing of the...more

In a closely watched case, the Court of Federal Claims last week refused to dismiss a health insurer’s putative class action against the Federal government for payments authorized under the Affordable Care Act. The Court’s...more

On December 12, 2016, CMS issued a Technical Alert that announced a change in reporting requirements for several different types of settlements with total payment obligation to claimant (TPOC) dates on or after January 1,...more

On October 21, 2016, the Indiana Supreme Court weighed-in on a closely watched case that drew much attention from the defense and plaintiff’s bar alike. Approximately one (1) year ago, I reported that the Indiana Court of...more

Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims. The letters are usually 20 to 30 pages long, not very specific, and...more

After fending off a motion for judgment on the pleadings in March 2015, a small hospital in Peoria, Illinois lost on summary judgment in its $300 million antitrust suit alleging illegal exclusive dealing and attempted...more

A California appellate court has declared physician Visha Dev the loser in his dating contest with Blue Shield Life and Blue Shield California. The contest arose when the Blues moved for summary judgment in Dev’s action...more

We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436.
Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

The Sixth Circuit, has decided, on remand from the Supreme Court, that the Michigan Health Insurance Claims Assessment Act (Act) is not preempted by ERISA. The Act imposes a 1 percent tax on all paid claims by insurers or...more

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